<!DOCTYPE html>
<html>
<body>
	<wicket:panel>
		<div>
			<h5>
				<label id="addressDisplayNameLabel">Please provide a short label for the address</label> <br> <input
					id="addressDisplayName" wicket:id="addressDisplayName" type="text" />
				<div wicket:id="addressDisplayNameFeedbackPanel" class="feedback"></div>

			</h5>
		</div>
		<div>
			<label id="contactFullNameLabel">Contact Name</label> <input type="text" id="contactFullName" wicket:id="contactFullName" />
			<div wicket:id="contactFullNameFeedbackPanel" class="feedback"></div>
		</div>
		<div id="addressLines">
			<table border="1">
				<tr>
					<td><label wicket:id="addressLinesLabel" id="addressLinesLabel">Postal Address</label>
					</td>
					<td>
						<table>
							<tr wicket:id="addressLines">
								<td><input type="text" id="addressLineValue" wicket:id="addressLineValue" />
								</td>
								<td><input wicket:id="remove" type="submit" value="remove" />
								</td>
								<td><div wicket:id="addressLineValueFeedbackPanel" class="feedback"></div>
								</td>
							</tr>
							<tr>
								<td colspan="3"><input wicket:id="addAddressLine" type="submit" value="Add Address Line" />
								</td>
							</tr>
						</table></td>
				</tr>

			</table>

		</div>
		<div>
			<label id="cityLabel"> City</label> <input type="text" id="city" wicket:id="city" />
			<div wicket:id="cityFeedbackPanel" class="feedback"></div>
		</div>
		<div>
			<label id="countryLabel">Country</label> <input type="text" id="country" wicket:id="country" />
			<!-- 			<div wicket:id="countryFeedbackPanel" class="feedback"></div> -->
		</div>
		<div>
			<label id="countyLabel">County</label>
				<select wicket:id ="counties"></select>
			<div wicket:id="countiesFeedbackPanel" class="feedback"></div>
		</div>
		<div>
			<label id="postCodeLabel">Post Code</label> <input type="text" id="postCode" wicket:id="postCode" />
			<div wicket:id="postCodeFeedbackPanel" class="feedback"></div>
		</div>
		<div id="phoneNumbers">
			<table border="1">
				<tr>
					<td colspan="4" ><label wicket:id="phoneNumbersLabel" id="phoneNumbersLabel">Phone Numbers</label>
					</td>
				</tr>
				<tr wicket:id="phoneNumbers">
					<td><input id="phoneNumberType" wicket:id="phoneNumberType" /></td>
					<td><input id="phoneNumberValue" wicket:id="phoneNumberValue" type="text" />
					</td>
					<td><input wicket:id="remove" type="submit" value="remove"></td>
					<td><div wicket:id="phoneNumberValueFeedbackPanel" class="feedback"></div>
					</td>
				</tr>
				<tr>
					<td colspan="4"><input wicket:id="addPhoneNumber" type="submit" value="Add Phone Number" />
					</td>
				</tr>
			</table>
		</div>

	</wicket:panel>
</body>
</html>